G20(P) Clinicians’ engagement with coding: improved documentation in discharge summaries & income recovery

With the current financial climate in NHS, there is a lot of work being done around financial sustainability. Most NHS trusts including our trust, runs with budget deficit. There is a huge responsibility on every NHS employee to make systems efficient. The delivery of optimal health care should be both excellent and cost-effective as ‘a penny saved is penny earned’. In Sep 2017, when I started as a trainee at Basildon Hospital, Dr. Rawal, Clinical Director of women and children, suggested looking at discharge letters and coding, as we are not doing well in coding the illnesses appropriately and therefore not getting the right financial income for the amount of clinical work done. Aim To improve the documentation in discharge summaries thereby improving the documentation and income recovery. Methods To quantify the problem, we did a pilot study and looked at the quality of discharge summaries retrospectively for the months of June- August 2017. We randomly analysed a set number of Paediatric emergency admission spells per month. We reviewed the notes, picked up the missing elements and the income generated. We liaised with our coding team and the problem summaries were reviewed. Then the codes and the HRGs (Health Resource Groups) were revised. Results Only 57% of the summaries had all essential details like diagnosis, co–morbidities, allergy, investigations, procedure and treatment. New HRGs recovered us a Financial Gain of £8,804. Based on the lessons learnt, we implemented the following recommendations on 20thMarch, 2018: We presented our findings to our team and reiterated the importance of doing quality discharge letters. Clinicians were educated by coders about codes, HRGs, Payment By Result (PBR) Weekly visit by a coder to Paediatric ward on Wednesdays. A Discharge check list was attached with all medical notes. Conclusions Prospectively looking at quality of discharge summaries since April, 2018, the findings so far are: Improvement in documentation of discharge summaries from 57% to 88% HRGs needing correction fell from 24% to 12% Much reduced income loss from 24% to 11% Ongoing action plans Mandatory fields in discharge letters Sepsis group looking at criteria for sepsis diagnosis Continued education to sustain improvement Other departments following our strategy